Children With Asthma Often Undertreated
Doctors say advances in asthma management should keep most kids symptom-free, but a new survey shows many young patients aren&#8217;t getting the treatment they need
WEB EXCLUSIVE
By Jennifer Barrett Ozols
Newsweek
Updated: 7:53 p.m. ET Dec. 11, 2004Dec. 10 - Epiphany Stalling doesn&#8217;t like to talk about how asthma sometimes keeps her up at night or keeps her from playing on the school basketball team.

&#8220;She plays it down a lot,&#8221; says her mother, Karen. Just a couple of days ago, the 11-year-old felt an attack coming on but wanted to stay outside to play with friends. &#8220;So she didn&#8217;t say anything,&#8221; Karen recalls.

By the time Karen called her daughter inside to their fourth-floor apartment in Brooklyn, N.Y., Epiphany could only make it to the third-floor landing before she had to sit down and catch her breath. &#8220;She was just huffing and puffing,&#8221; says her mom.

Epiphany has a short-acting inhaler she uses at such times. But that hasn&#8217;t always been enough to prevent an asthma attack, which can result in emergency-room treatment.

&#8220;A lot of times, people think that if they have asthma, they are supposed to be sick,&#8221; says Dr. Paul Williams, a pediatrician and former president of the Washington State Society of Allergy, Asthma and Immunology. &#8220;But one thing I try and impress on patients is that asthma can be controlled; you shouldn&#8217;t let asthma control you.&#8221;

Pediatricians and asthma specialists say that with new medications, the disease need no longer interfere with school, sports or sleep&#8212;or lead to regular emergency-room visits. But many patients like Epiphany don&#8217;t appear to have gotten the memo. A new survey released Wednesday by Asthma Action America, a national education campaign supported by GlaxoSmithKline that includes the American Lung Association and more than 20 other organizations, found that many children with asthma were falling far short of the treatment goals established by the National Institutes of Health.

Great article, really helpful. I agree with you, I think doctor should also give peak flow meter to children's, to let them know how well their lungs are doing? It also helps in recognizing the duration of treatment of asthma for them.

Granny wheezes sumpin' awful when her asthma acts up...Crippling viral infections 'cause asthma'9 September 2012 - How could a virus increase the risk of asthma?

Viral infections in newborns "cripple" part of the immune system and increase the risk of asthma later in life, US researchers studying mice have said. They showed infections by respiratory syncytial virus (RSV) stripped immune cells of their ability to calm down inflammation in the lung's airways. They say their findings, published in the journal Nature Medicine, will help develop ways of preventing asthma. The charity Asthma UK said the study had "really exciting" potential. When something irritates the airways of a patient with asthma, the airways become tightened, inflamed and produce too much sticky mucus. All of this can make breathing difficult.

Previous studies have shown a link between repeated lung infections with RSV and developing asthma later in life. One Swedish study showed showed 39% of infants taken to hospital with RSV had asthma when they were 18. However, only 9% of infants who were not ill developed asthma. How the virus might be able to do this was, however, unknown. Now a team of researchers at the University of Pittsburgh School of Medicine believe they have an explanation.

Their experiments on mice showed the virus impaired the ability of a specific part of the immune system, called regulatory T cells, to calm inflammation. Inflammation is an important part of dealing with an infection. However, for asthma patients, chemicals in air which come from ordinary things like dust mites, pets and mould can trigger an inappropriate inflammatory response. Infection with RSV led to a "complete loss of suppressive function" of the regulatory T cells, after which the mice developed asthma-like symptoms," researchers Prof Anuradha Ray and Prof Prabir Ray told the BBC.
Early window

They said there might be a window in early life when the cells were vulnerable to being "crippled". They think the finding could help scientists devise treatments which prevent some people developing asthma. "We feel that both prophylactic and therapeutic approaches can be developed. "This is especially desirable in infants who have a strong family history of asthma." Malayka Rahman, from Asthma UK, said: "This research provides vital information on how viruses interact with our immune cells and why this might lead to an increased risk of asthma. "What's really exciting is the potential of these findings to translate into new treatments for asthma in the future."

New way to treat asthma...New Study Could Change Treatment for Asthma October 19, 2012 - Global treatment guidelines for asthma could change as a result of a study led by a researcher at the University of Texas Medical Branch.

Most adults who have mild or moderate asthma are told to use their inhalers twice daily, even if they don't have symptoms. The medicine in those inhalers are corticosteroids, which open a person's airways and decrease mucus so it's easier to breathe. Inhaled corticosteroids are the most common and the most effective form of therapy for asthma. With asthma, the airways of the lungs become inflamed and swollen. It's triggered by a wide range of factors, some genetic, some environmental. Dust, air pollution or smoke can set off an asthma attack. Change of seasons when there are a lot of particles in the air can also trigger an attack.

Frank Grizzaffi knows this routine well. There was a regime that I was supposed to follow, it was two puffs in the morning and two puffs in the evening, said Grizzaffi. That was before Grizzaffi participated in a study that involved 10 academic centers and more than 300 adults with mild to moderate asthma. The doctors evaluated the patients and determined the lowest possible dose of medication that would control their asthma. Dr. William Calhoun led the study. The amount of corticosteroid that a patient received during the trial was dependent upon the amount of symptoms they had. When they had fewer symptoms they got less steroid, when they had more symptoms they got more steroid, he said.

After adjusting medication, doctors looked at three different ways of treating the patients. One group received their adjusted dose of steroids and took them as usual. Another group had their steroid levels adjusted after taking sophisticated breath tests for asthma and a third group was told to use inhalers only when their symptoms flared up. What they found was that patients in this last group did just as well as those in the other two groups. The major difference is they only used half as much medication. The symptoms-based arm resulted in a reduced use of inhaled corticosteroids, a 50 percent reduction. It also resulted in a reduction in exacerbation in the autumn, a time when exacerbation are typically high and it also resulted in a reduction in absenteeism from school or work, said Calhoun.

These findings could change international standards of care. It would reduce costs because patients would need less medication and it would also limit long-term exposure to corticosteroids. Under his doctor's care, Frank Grizzaffi no longer needs to follow his old regimen. Ill take one puff in the morning and that usually takes care of it the rest of the day. I feel great, I feel really good, he said. Dr. Calhoun advises patients with mild to moderate asthma to check with their doctors to see if this strategy might work for them. The study was published in the Journal of the American Medical Association.

Fast food often contains high levels of "unhealthy" fat...Fast-food 'linked to childhood asthma and eczema'14 January 2013 - Eating fast food three times a week may lead to asthma and eczema in children, say researchers who have looked at global disease and dietary patterns.

Data from more than 500,000 children in more than 50 countries suggests poor diet may be to blame for rising levels of these allergy-related conditions. Those who ate fast food, such as take-away burgers, risked severe asthma, eczema and itchy, watery eyes. Eating plenty of fruit appears to be protective, Thorax journal reports. Fast food often contains high levels of saturated- and trans-fatty acids, which are known to affect immunity, while fruit is rich in antioxidants and other beneficial compounds, say the researchers.

In the study, children in their early teens who ate three or more weekly servings of fast food had a 39% increased risk of severe asthma. Six- and seven-year-olds had a 27% increased risk. Eating three or more portions of fruit a week cut the risk of severe asthma, eczema and rhinoconjunctivitis by between 11% and 14%.

The study authors, Prof Innes Asher, from the University of Auckland in New Zealand, and Prof Hywel Williams, from the University of Nottingham in the UK, said: "If the associations between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally." Generally, people with asthma do not have to follow a special diet. In some cases, certain foods, such as cow's milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives, can make symptoms worse.

Malayka Rahman of Asthma UK, said research suggests that a person's diet may contribute to their risk of developing asthma and that eating healthily may have a beneficial effect. "Evidence suggests that the vitamins and antioxidants found in fresh fruit and vegetables have a beneficial effect on asthma therefore Asthma UK advises people with asthma to eat a healthy, balanced diet including five portions of fruit or vegetables every day, fish more than twice a week, and pulses more than once a week."

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